ICAAC HIV Poster Roundup #2: Clinically Relevant Findings

By Myles Helfand

From TheBodyPRO.com

September 20, 2011

Here's a quick sampling of some of the more clinically relevant HIV-related posters (from a U.S. clinician's standpoint) that were presented at ICAAC 2011 on Monday, Sept. 19. To shake things up after I put yesterday's roundup in ascending order by poster number, the order of these summaries will be in descending order. (Try to keep your hat on.)

CD4:CD8 Ratios Infrequently Recover: A CD4:CD8 ratio roughly in the 1 to 2 range is considered typical of healthy adults, but such a ratio tends to be relatively uncommon among people with HIV. Could highly active antiretroviral therapy (HAART) restore that ratio? A team of Canadian researchers studied the CD4:CD8 ratio of more than 4,500 HIV-infected individuals, 81% of them men, who were taking antiretroviral therapy. After an average of three years of follow-up, just 7% of the volunteers saw their ratio normalize to 1.2 or higher. Those with a normalized ratio appeared to have a somewhat reduced risk of dying or developing an AIDS-defining illness. (Leung et al; poster H1-1409)

Facial Fillers = Bigger Smiles: Poly-L-lactic acid (PLA; Sculptra, New-Fill) is approved in the U.S. to treat facial lipoatrophy in people with HIV; polyacrylamide hydrogel (PHA; Aquamid) is not. French researchers conducted a 96-week, randomized, open-label, noninferiority study comparing the two, and found that the two were pretty similar nearly across the board in terms of visible impact and quality-of-life assessments. That said, more pain was reported with PHA injections, and there was a trend toward more long-term complications among PHA recipients, including potentially serious granuloma-like lesions at the injection site. (Lafaurie et al; poster H1-1399a)

Neurosyphilis Concerns: HIV-infected people may face a higher risk of neurosyphilis in addition to more typical syphilis infection, according to a German study. An examination of cerebrospinal fluid in 80 HIV/syphilis-coinfected people, almost all of whom were men who have sex with men, found signs of early neurosyphilis infection in 17.5% of the volunteers. Only two-thirds of the volunteers showed any symptoms of early syphilis infection, reinforcing the importance of regular testing even in the absence of clinical symptoms. (Esser et al; poster H1-1396)

Tuberculosis and HIV: This conference offered a couple of important reminders that, even in people with advanced HIV disease and tuberculosis (TB), recovery is possible -- but it really would be nice to diagnose people before they're on death's door, if possible. Thai researchers found a three-year survival rate of 91% among HIV/TB-coinfected people with a baseline CD4+ cell count at or below 75 who began antiretroviral therapy. However, survival jumped to 98% at CD4+ cell counts above 75. People who developed an opportunistic infection after initiating HIV treatment had a nine times higher risk of death. (Punyaratabandhu et al; poster H1-1394)

Cardiovascular Markers: An international coterie of studies attempted to clarify the role of particular biomarkers and measurement systems in signaling inflammation or potential cardiovascular risk in HIV-infected people. Researchers from Italy reported that osteoprotegerin, whose production is stimulated by estrogen and is linked to bone and cardiovascular problems, was less present in HIV-infected men on PIs than in HIV-uninfected men. They also found that carotid intima-media thickness appeared greater in men with lower osteoprotegerin levels, suggesting a protective effect. (D'agostino et al; poster H1-1391)

Meanwhile, researchers in Korea found signs that high levels of sRAGE, or soluble receptor for advanced glycation end products, in the blood appeared to have a protective effect against subclinical atherosclerosis. (Jeong et al; poster H1-1393)

Lastly, over in Spain, researchers attempted to use pulse wave velocity measurements to assess cardiovascular risk in HIV-infected people, but found they often didn't agree with what Framingham risk scores would suggest. (Tenorio et al; poster H1-1392)

For more summaries of clinically relevant, HIV-related posters from ICAAC, check out roundup No. 1.

Myles Helfand is the editorial director of TheBody.com and TheBodyPRO.com.

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Please note: Knowledge about HIV changes rapidly. Note the date of this summary's publication, and before treating patients or employing any therapies described in these materials, verify all information independently. If you are a patient, please consult a doctor or other medical professional before acting on any of the information presented in this summary. For a complete listing of our most recent conference coverage, click here.

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